Editor’s Note: This post was co-authored by Kerianne Graham and Sarah Markovitz. An expanded version appeared in Becker’s Hospital Review.
According to the Centers for Disease Control and Prevention (CDC), about 1 in 25 hospital patients have a Healthcare-Acquired Infection (HAI) — that is, an infection that develops as a result of medical care — on any given day, and in 2011 an estimated 75,000 patients with HAIs died during hospitalization. Treatment for these infections has led to annual costs of between $28 and $45 billion, and with changing pay-for-performance penalties, their impact on a hospital’s bottom line will only increase.
Whether you work in a hospital environment, parallel to it, or only engage with it when you or a loved one falls ill, chances are each of us will be somehow affected by an HAI, which is why our awareness of the issue at hand is critical.
Although tracking the initial cause of an HAI can be difficult, studies have identified the leading causes, starting with human behavior and compliance: the CDC identifies hand-washing as “the single most important method to prevent hospital infections.” Hand-washing alone, however, cannot eliminate HAIs completely, because contact with bacteria-laden objects and surfaces can lead to re-contamination, and we’ve learned from more than one institution that turn-over time for cleaning is a major challenge.
It has became clear that eliminating HAIs requires a “systems” approach, with multiple interventions in the design and function of hospitals and clinics. As architects, we recommend our clients take three approaches to make a difference: reduce the number of high-touch surfaces, eliminate potential host surfaces for pathogens, and increase compliance of medical personnel.
Approximately 20-40% of HAIs are the result of infection transferred by human touch. Therefore, we suggest reducing the times that staff interact with unnecessary objects before caring for the patient. We turned to the CDC’s list of high-touch surfaces to rethink how staff interact with these objects. Some suggestions can be simply implemented, like trading doorknobs with wave sensors (#1), installing touch-free faucets and hand dryers (#2) and built-in, closed bedpan washers (#3).
Other suggestions require more operational changes: using room-specific, UV-sanitized tablets (#4) for documentation or as controllers for anything from lights to temperature. Still other solutions may seem counterintuitive, such as duplicating the overbed table (#5) — an additional surface is introduced, but it allows for separation of staff and patient surfaces — or storage alcoves where equipment can be stored until needed (#6).
Eliminate Pathogens / Hosts
Microbes are everywhere, but reducing the number of host sites can reduce the chance of infection. For instance, replacing cubicle curtains with electrochromatic “smart glass” (#7) removes an element that can harbor microbes easily passed by contact transmission.
The room layout also makes a difference; inboard bathrooms, by keeping humidity away from cold exterior walls, reduce the likelihood of condensation and mold (#8). The exterior also walls should include appropriate vapor barriers and insulation (#9).
Finally, if we keep harmful microbes out of the patient environment, we can worry less about how we remove them. An average of 421,000 units of bacteria are tracked in on the outside surface of each shoe, including E. coli, which indicates contact with fecal matter; shoe cover dispensers are a simple solution (#10).
None of these features matter, however, without the cooperation of clinical staff. To make it easier for staff to follow hand hygiene and infection prevention guidelines, the environment should be optimized with strategic, easily accessible locations for such seemingly simple elements as sanitizer dispensers, masks, gloves, shoe covers, sharps containers, garbage receptacles and contaminated supply disposal units (#11), along with automatic hand washers and dryers at the entry (#12).
Where low-tech solutions aren’t enough, RFID technology can be used for immediate feedback and compliance reports, (though some worry about the “big brother” aspect), and when paired with color-changing LED lighting can provide an indicator and record of hand-washing (#13). Low-tech and high-tech strategies alike, however, require the involvement and buy-in of the staff.
HAIs have no simple solution. Product representatives and architects alike must prove that their solutions will do more good than harm, and the quantity of evidence needed to declare something safe is much greater than the evidence needed to declare it poses an unnecessary risk. For instance, a well-known U.S. institution recently banned antimicrobial additives from surfaces in its facilities because the known risk from harmful chemicals outweighed the promised rewards in infection prevention.
With limited scientific proof, and limited existing regulations, it’s vital that we continue with this research to better protect healthcare patients. HAIs may never be eliminated completely, but with careful design, we can build much healthier and safer environments.
Banner image courtesy of COD Newsroom/Flickr.
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